Abstract
OBJECTIVES: This study aims to construct a multivariable relationship network between nurses' patient safety competency (PSC) and patient safety culture (PSCu) by using network analysis methods, reveal the interaction paths, and provide a basis for precise safety management from the perspective of complex adaptive systems. DESIGN: A multi-center cross-sectional study. SETTING: This study was conducted in primary and secondary hospitals in the northeastern part of Chongqing, China. PARTICIPANTS: A survey was conducted on 642 primary care nurses from 87 medical institutions using the convenience sampling method. METHODS: The web-based survey included a general information questionnaire, the Patient Safety Competency Nurse Evaluation Scale (PSCNES) and the Chinese version of the Hospital Survey on Patient Safety Culture (HSOPSC)1.0 questionnaire. The R software (Version 4.2.0; Vienna, Austria) was used to conduct network analysis on the data. RESULTS: A total of 642 nurses were included in this study. In the HSOPSC dimension, the highest score was observed for teamwork within units (4.21 ± 0.68), whereas the lowest score was recorded for nonpunitive response to error (3.17 ± 0.92). Among the PSCNES dimensions, the one with the highest score was clinical practice (3.97 ± 0.93), and the lowest score was associated with patient oriented (3.80 ± 1.04). Network analysis shows that department level organizational learning, continuous quality improvement, and feedback about errors served as the central nodes in the network. Notably, feedback about errors exhibited the strongest intermediary role. In contrast, the events reported in the past 12 months was identified as the node with the weakest interconnections. CONCLUSION: "Feedback about error" should be taken as the key intervention target to strengthen organizational learning, build a non-punishment culture, enhance teamwork, and improve nurses' patient safety competency and patient safety culture in a two-way manner.